Quality of diagnosing acute poisoning by ambulance paramedics

Abstract

Aim. The assessment of quality of diagnosing acute poisoning by ambulance paramedics.

Methods. Retrospective analysis of the rate of diagnostic discrepancies and undifferentiated diagnoses in 1 242 patients delivered by ambulance paramedics of Kazan to the hospital with the diagnosis of acute poisoning.

Results. Referral diagnosis of acute poisoning among patients delivered by ambulance paramedics to the diagnostic department of the hospital was not confirmed in 792 cases, among which in 683 cases admission was not needed due to the absence of indications. Among refusals of hospitalization the majority of patients (70.8 %) were in the state of intoxication of various etiologies and healthy patients. In 8.5 % of cases of diagnostic discrepancies of acute poisoning paramedics delivered to the hospital patients with severe urgent somatic pathology - urosurgical, neurological, surgical, therapeutic, etc. The rate of diagnostic discrepancies in the group of alcohol, drug, undefined substances and mushroom intoxication was higher - 71.5 %, than in the group of medication and carbon monoxide intoxication - 39.7 %. In poisoning with impaired consciousness a direct dependence of the rate of diagnostic discrepancies on the rate of impaired consciousness was observed. The rate of undifferentiated diagnoses in the first group of poisoning was also higher - 82.3 %, than in the second group - 45. 8%, but no dependence on the impairment of consciousness was observed among patients.

Conclusion. High rate of diagnostic discrepancies (63.8 %) and undifferentiated diagnoses (71.1 %) are the consequence of lack of competence in medical toxicology among ambulance paramedics. In 98.2 % of cases, the probable etiological diagnosis of the disease, suspected as acute poisoning, in the study group of patients could be diagnosed using diagnostic methods available for paramedics.

Keywords

poisoning / ambulance / diagnostic discrepancies

References

[1] Meditsinskaya toksikologiya: nacional’noe rukovodstvo. (Medical toxicology: national guide.) Ed. by E.A. Luzhnikov. Moscow: GEOTAR-Media. 2012; 928 p. (In Russ.)

[2] Медицинская токсикология: национальное руководство. Под ред. Е.А. Лужникова, М.: ГЭОТАР-Медиа. 2012; 928 с.

[3] Kłys M., Kowalski P. Diagnostic medical error as an overinterpretation of toxicology screening combined with inadequate clinical assessment. Arch. Med. Sadowej Kryminol. 2011; 61 (4): 377–382.

[4] Kłys M., Kowalski P. Diagnostic medical error as an overinterpretation of toxicology screening combined with inadequate clinical assessment. Arch. Med. Sadowej Kryminol. 2011; 61 (4): 377-382.

[5] Li Y., Yu X., Wang Z., Wang H. Ethanol poisoning together with organophosphate exposure: a difficult clinical diagnosis because of physician anchoring. Alcohol alcohol. 2008; 43 (6): 650–652.

[6] Li Y., Yu X., Wang Z., Wang H. Ethanol poisoning together with organophosphate exposure: a difficult clinical diagnosis because of physician anchoring. Alcohol alcohol. 2008; 43 (6): 650-652.

[7] Barsukova I.M., Glushkov S.O. Condition of quality of medical care when rendering the emergency medical service. Skoraya meditsinskaya pomoshch’. 2014; (3): 8–13. (In Russ.)

[8] Барсукова И.М., Глушков С.О. Состояние качества медицинской помощи при оказании скорой медицинской помощи. Скорая медицинская помощь. 2014; (3): 8-13.

[9] Salikhov I.G., Akhmerov S.F. Neotlozhnye sostoyaniya v praktike terapevta. (Emergencies in internal medicine. Study guide.) Kazan: Idel-Press. 2007; 376 p. (In Russ.)

[10] Салихов И.Г., Ахмеров С.Ф. Неотложные состояния в практике терапевта. Казань: Идел-Пресс. 2007; 376 с.

[11] Tarakanova L.I., Kozitsina F.G. Analysis of diagnostic discrepancies at prehospital phase. Skoraya meditsinskaya pomoshch’. 2001; (3): 67. (In Russ.)

[12] Тараканова Л.И., Козицина Ф.Г. Анализ расхождения диагнозов на догоспитальном этапе. Скорая медицинская помощь. 2001; (3): 67.

[13] Graber M.L. The incidence of diagnostic error in medicine. BMJ Qual. Saf. 2013; 22: ii21–ii27. DOI: 10.1136/bmjqs-2012-001615.

[14] Graber M.L. The incidence of diagnostic error in medicine. BMJ Qual. Saf. 2013; 22: ii21-ii27. DOI: 10.1136/bmjqs-2012-001615.

[15] Heuer J.F., Gruschka D., Crozier T.A. et al. Accu­­racy of prehospital diagnoses by emergency physi­cians: comparison with discharge diagnosis. Eur. J. Emerg. Med. 2012; 19 (5): 292–296. DOI: 10.1097/MEJ.0b013e32834ce104.

[16] Heuer J.F., Gruschka D., Crozier T.A. et al. Accuracy of prehospital diagnoses by emergency physicians: comparison with discharge diagnosis. Eur. J. Emerg. Med. 2012; 19 (5): 292-296. DOI: 10.1097/MEJ.0b013e32834ce104.

[17] Kostopoulou O., Delaney B.C., Munro C.W. Diag­nostic difficulty and error in primary care — a systematic review. Family Practice. 2008; 25 (6): 400–413.

[18] Kostopoulou O., Delaney B.C., Munro C.W. Diagnostic difficulty and error in primary care - a systematic review. Family Practice. 2008; 25 (6): 400-413.

[19] Schiff G.D., Hasan O., Kim S. et al. Diagnostic error in medicine: analysis of 583 physician-reported errors. Arch. Intern. Med. 2009; 169 (20): 1881–1887. DOI:10.1001/archinternmed.2009.333.

[20] Schiff G.D., Hasan O., Kim S. et al. Diagnostic error in medicine: analysis of 583 physician-reported errors. Arch. Intern. Med. 2009; 169 (20): 1881-1887. DOI:10.1001/archinternmed.2009.333.

[21] Singh H., Giardina T.D., Meyer A.N. et al. Types and origins of diagnostic errors in primary care settings. JAMA Intern. Med. 2013; 173 (6): 418–425. DOI: 10.1001/jamainternmed.2013.2777.

[22] Singh H., Giardina T.D., Meyer A.N. et al. Types and origins of diagnostic errors in primary care settings. JAMA Intern. Med. 2013; 173 (6): 418-425. DOI: 10.1001/jamainternmed.2013.2777.

[23] Zwaan L., de Bruijne M., Wagner C. et al. Patient record review of the incidence, consequences and causes of diagnostic adverse events. Arch. Intern. Med. 2010; 170 (12): 1015–1021. DOI:10.1001/archinternmed.2010.146.

[24] Zwaan L., de Bruijne M., Wagner C. et al. Patient record review of the incidence, consequences and causes of diagnostic adverse events. Arch. Intern. Med. 2010; 170 (12): 1015-1021. DOI:10.1001/archinternmed.2010.146.

[25] Khusainova D.F., Sokolova L.A., Davydova N.S. et al. Analysis of diagnoses’ divergence of ambulance service in cardiovascular disease. Vrach skoroy pomoshchi. 2015; (3): 21–27. (In Russ.)

[26] Хусаинова Д.Ф., Соколова Л.А., Давыдова Н.С. и др. Расхождения диагнозов скорой медицинской помощи и стационаров в городе Екатеринбурге. Врач скорой помощи. 2015; (3): 21-27.

[27] Shchepin O.P., Medik V.A. Obshchestvennoe zdorov’e i zdravookhranenie. (Public health and health care.) Moscow: GEOTAR-Media. 2011; 592 p. (In Russ.)

[28] Щепин О.П., Медик В.А. Общественное здоровье и здравоохранение. М.: ГЭОТАР-Медиа. 2011; 592 с.

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